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Enin

We are so happy to announce our newest family member! His name is Enin (pronounced N-N). Enin is an adorable boxer, shepherd mix puppy who has changed out lives forever. Like most things in life there was no plan to find Enin. Instead Enin found us.

I have wanted a dog for as long as I can remember, but without the full support of everyone in the family it was just not going to happen. Magically, the stars were aligned this month. I was on the Lucky Paws Rescue website and found a dog I thought would be perfect for our family: her name was Bay. She was found pregnant in a field in California where someone had left her. Somehow she was brought up to Oregon and gave brith to 9 puppies. Bay was described as being the perfect family dog. She was 1.5 years old and loved children, cats, other dogs, and basically everyone and everything.

Our family headed out to meet her and her pups were going to be there too. She was a wonderful dog. She was gentle with her pups and her pups were as well mannered as she was. One by one her pups were adopted. Three families (including our own) wanted to adopt Bay. After about 2 hours we were able to meet her and she was just as wonderful as she was described. All 3 families wanted her. The volunteer at Lucky Paws picked one of the applications at random and we were not the family that was picked. Sadness…..

The volunteer told us there were 3 puppies left in case we wanted to adopt one of them. My husband and I looked at one another as our 8 year old son and 6 year old daughter were well on their way to meet the puppies. Immediately they found a pup they liked, or rather they were being licked by a puppy that had chosen them. This is how we came to have Enin in our lives. And we couldn’t be happier.

So many times in life we are busy looking for happiness. If only we stopped looking and allowed it to find us.

Conference

Recently I went to an Endocrinology conference at the University of Washington in Seattle. It was a great conference with topics including: diabetes, testosterone, thyroid problems, PCOS and much more. There were also pharmaceutical companies present. I have always grappled with understanding the presence of pharmaceutical companies at medical conferences. You always have to take everything that’s said with a grain of salt (unless you have high blood pressure, then don’t!). Medications are great when you need them, but they also come with side effects and too many can cause as many problems as they are trying to help.

My goal for my patients has always been to be on the least number of medications possible. I had a professor tell me once: “You should not be on more medications than the square root of your age”. How true! We now know that we can heal many of our health problems simply by eating right and exercising. I know I try everyday to make good decisions, but sometimes I don’t. Then I have to make a correction, and on and on it goes. Having a holistic approach to healing a person comes from appreciating that the body can heal itself and sometimes it needs help through medicine. Knowing the difference is part of the art of medicine.

So, yes, I did learn a lot about disease processes, treatment options, and evidence based medicine. One of the speakers commented that although we are taught to practice medicine based on evidence, we are too often practicing medicine to what is covered under a patient’s medical plan. We could save on some of these costs if we just sat down with our patients and talked about what they could do to improve their diet.

“Let food be thy medicine and medicine be thy food.”

Hippocrates

Walking away from a “Big Box Clinic”

Ms. Smith has an appointment at 8 AM to go over her diabetes, discuss her recent diagnosis of breast cancer and she also has some increased pain in her abdomen. We have 20 minutes scheduled for the visit. During the appointment we go over labs, adjust some medications, discuss future tests for her abdominal pain and go over her breast cancer treatment plan. It is an emotional visit as well. She feels comforted knowing the we will get through this together.

My patients have told me they feel cared for, listened to and do not feel like a number. However this is not how most medical practices work….

Most doctors today are discouraged and walk away from medical practice altogether because of Big Box Medicine. If you haven’t heard of this term before: it is an industrialized version of what medicine used to be. It causes your doctor to go to work and get on a treadmill. It treats patients as widgets and doctors as factory workers. Appointments are scheduled for 15-20 minutes (maybe half of which will be spent in face-to-face time with your doctor) to address multiple health issues. In turn the response has been for doctors to turn into referral and pill mills. There is an emphasis on treating illness rather than promoting health and prevention. There isn’t much profit if you aren’t sick.

Job satisfaction for physicians is at the lowest in decades. Doctors spend time in between seeing patients, answering phone calls, refilling medications, doing tons of paperwork, interpreting Xrays, MRIs, and labs. Due to these pressures younger doctors no longer choose primary care. Those toward the end of their careers are thinking of early retirement. This is further worsening the primary care shortage.

It’s time to get off the treadmill. The article below highlights some of the benefits of the Direct Primary Care (DPC) model. Patients should be in a partnership with their doctor to create the best, healthiest version of themselves.

“The message to our nation could not be clearer: Stop spending more on health care. Convert to DPC and save.”

Direct Primary Care Is a Sensible Workforce Solution

On Opiates…

One of the many crises facing our nation is the opiate crisis. There are many hypotheses as to how we got here but there is no doubt that things need to change. The majority of drug overdoses are related to heroin and opiate use. More people are dying from overdoses of opiates, heroin and benzodiazepines than cocaine. In the past 20 years opiate prescriptions have tripled. The opiate overdose epidemic crosses age and racial lines.

Newer prescribing guidelines suggest not starting on opiates in the first place and if they need to be prescribed they should be given for the shortest period of time and then tapered off. Of course, there are the rare occasions where opiate use may become chronic however when more people are dying from prescription drug use than car accidents, something needs to change. In an ideal world there would be no blaming of patients or doctors. There would be more responsible use of these medications.

I have a lovely patient whom I met a few years ago when she was on chronic opiates. I wanted to find the reason why she needed the medication and initially she had the same response – fear – as so many of my patients reasonably do, thinking somehow I was going to take their needed medication away. I told her I had to intention of doing that but we should find a cause for the pain and treat that instead. She reluctantly agreed. Through some additional testing I diagnosed her with Rheumatoid arthritis. She began seeing a rheumatologist and reported feeling better than she had in years. To this day she is thankful that we got her off the opiates and treated the underlying cause of her illness.

Not all stories end this way but there should always be an attempt to trial off of these medications. If patients and doctors work together there will be an end to this epidemic. Please see the Frontline special “Chasing Heroin” for more information on this topic.

Funeral

I went to a funeral today. It was for one of my favorite patients. When I met her she was in her 70s and about a week ago she passed away at age 84. She was an absolute delight! I loved seeing her name on my schedule knowing she would brighten up my day with her smile. She had a wonderful spirit. She talked really, really fast and had things to do and places to be. I was honored to have her share her life with me. Of course, I helped her with her medical issues but she never knew what she did for me.

When I met Irene she was on the go, as usual. We would go over her medications, her health issues, what activities she was involved in at the time and planned out when we would see each other again. At her funeral I found out so much more about the life that she lived. It started off with her being raised on a farm, doing chores from dawn to dusk. Then she went out on her own, got an education, earned a living, and traveled the world with her girlfriends. All while meeting adventures with curiosity and joy. She started off as  a secretary who was promoted to the finance department because she was just that smart. She eventually met her husband and they had a family. Her husband died when her daughter was 14 and her son was 18. She never married again.

Irene loved to bake. Irene baked cookies for her family, her friends and her church. She baked breads for her son, since he didn’t like store brought bread. She stopped baking when I diagnosed her with memory loss. Eventually we found out she had Alzheimer’s. Irene was still Irene for a while. She looked the same, she spoke in the same manner but she acted differently. That is the curse of a disease that effects the mind.

During this time I met her son. He would now accompany her to appointments. Irene was on all the right medications but she was no longer Irene. I loved her. Slowly her health waned and the last time I saw her she was urgently added on to my schedule for trouble speaking. I immediately admitted her to the hospital however she still passed away a few days later. A systemic blood infection had taken her life.

I went to a funeral today and I cried. I cried because I did not know this beautiful woman during the times she lived life to the fullest. I cried because she would never be able to tell me about those times again. I cried because I missed her and I wouldn’t see her smile.

I miss you Irene. Thank you for letting me be a part of your wonderful life.

A Week in the Woods

It was a Fall day when it all suddenly changed. I had decided to spend a week at Breitenbush resort on a medical retreat led by Pamela Wible. The retreat came with a promise of renewal and leaving with a new vision of medicine. I spent time in seminars, talking to other medical professionals and felt like I belonged to this community of healers. These physicians were trying to find their joy of medicine that was lost somewhere along the way, for a variety of reasons. This was a chance to regain it.

We talked about the healers we wanted to be when we started our journey many, many years ago. I was an idealist. I wanted to help as many people as I could by simply listening to them. Then by applying my knowledge and training I could heal them. When I went to medical school, things weren’t so simple anymore. The long hours of studying, followed by 30 hours shifts at the hospital every 4 days, and constant testing were par for the course. However we weren’t expecting to be berated by our senior physicians in the process. Neither were we expecting to lose some of our humanity as a result. Those healers has been abused along the way and now they were abusing others. This continued into residency. After residency we believed things were finally going to be the way we had dreamed all along. But they weren’t and we were told to persevere.

All these experiences brought us to the woods that week. I was comforted in knowing the path others had taken was similar to mine. It was like sharing war stories. We were all harmed somewhere along the way. We were all here to heal ourselves so we could heal others better. 

I left the woods forever changed. I was finally given permission to be the physician I had always dreamed of. I could spend time with my patients. I didn’t have to maintain a “professional distance” to provide great care. I could be myself as a doctor.